Evidence Based Interventions Programme

As a representative of the British Association of Dermatologists (BAD), I was delighted to have been involved in this NHS Evidence Based Interventions (EBI) programme. Most regions across the UK have had some form of ‘cosmetic policy’ for a number of years, but what has been lacking is consistency. I saw the EBI programme as an opportunity to reduce variation in policy between regions and to ensure that those patients who need treatment are not denied it.

The BAD’s experience with national policy-making in the past has often seen us being involved too late to help shape the process, however, working with the EBI has been a real pleasure in this regard. It is so important that appropriate stakeholders are involved in these types of initiatives to ensure that we get it right for our patients.

Cosmetic interventions appear to be straight forward and to take up little of our time, so why all the fuss? Firstly, although the procedures are straight forward, they do carry significant risk of scarring and infection. Secondly, they do not take up little time. Each patient must be seen in clinic for assessment prior to a procedure, which would be booked at a separate time. The procedure generates specimens that then need to be processed by the laboratory, reported by a consultant histopathologist, reviewed by the dermatologist and communicated to the patient.

Consider the additional resources required for each of these steps, operating theatre time and staff, equipment sterilisation, transport of samples, administration and secretarial time and so on. Multiply this by the thousands of patients across the NHS currently having such procedures and you start to realise the significant time and resources that is spent on lesions which are not causing harm.

We know how desperately short of dermatologists we are across the whole of the UK, so don’t we as professionals have a duty to manage the scarce resources as best we can? Certainly that’s the line the GMC takes in its most recent iteration of Good Medical Practice where it says we have a duty to ‘make the best use of the resources available.’

As a specialist in skin cancer and disabling skin diseases I should be focussing on conditions which may cause harm or significantly affect quality of life and which need medical attention. By not treating benign cosmetic lesions the NHS is able to gain substantial additional ‘dermatology time’. For patients with severe inflammatory skin disease this means that they are seen quicker and treated quicker, enabling them to return to work, restore their social life and reduce the impact on their family life that these skin diseases so often cause. For patients with suspected skin cancer they will be seen quicker in clinic and the surgical waiting time will be reduced so that treatment is quicker.

One thing that is important to stress is that the EBI policy is about benign cosmetic lesions. It does not include benign lesions which are troublesome, which may be painful, bleed or become regularly infected, these are still able to be treated.

As resources become ever more stretched, money ever tighter and demand always increasing, I for one am glad to be backing a well thought out programme, which will benefit patients and strained dermatology departments.